Cardiac Complications After 3-Column Osteotomy for Adult Spinal Deformity Patients With Formal Cardiac Clearance:...

Area of Science:

• Spine surgery
• Cardiology
• Anesthesiology

Background:

• A subset of patients undergoing 3-column osteotomy (3CO) experience cardiac complications (CCs) even after formal cardiac clearance.
• Identifying these complications is crucial for patient safety in adult spinal deformity (ASD) surgery.

Purpose of the Study:

• To determine the incidence and risk factors for CCs in 3CO patients with prior cardiac clearance.
• To evaluate the effectiveness of the Revised Cardiac Risk Index (RCRI) and preoperative metabolic equivalent (MET) functional ability in predicting perioperative CCs.

Main Methods:

• Retrospective review of 390 adult spinal deformity (ASD) patients who underwent 3CO deformity correction (2006-2019).
• Multivariate and recursive partitioning analyses were used to identify risk factors for CCs.
• Assessment of RCRI and MET functional ability for prediction of perioperative CCs.

Main Results:

• The overall CC rate was 9.7%.
• Independent risk factors for CCs included older age (>81 years), increased blood loss, and prior spinal fusion.
• RCRI and MET functional ability were not significantly associated with CCs.
• In patients ≤81 years, blood loss >3900 mL and ejection fraction (EF) ≤54.5% were associated with higher CC rates.

Conclusions:

• The RCRI and MET functional ability have limited utility for risk assessment in 3CO patients with formal cardiac clearance.
• Patients over 81 years old are at significantly higher risk for CCs.
• For younger patients, cardiac EF and blood loss are important factors for risk stratification of CCs.